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Invisible Deaths: Katherine Boo's follow-up series on the fatal neglect of D.C.'s retarded. |
 The District's Forest Haven asylum has become the domain of vandals and addicts years after its residents were moved to group homes. (Michael Williamson The Washington Post) Photo Gallery D.C.'s Troubled System Forest Haven Is Gone, But the Agony Remains Olympic Achievements Out of Reach An Elaborate Structure of Care Hundreds of Abuses, No Fines Monday: Residents Languish; Profiteers Flourish Nonprofits Struggle in Current of Greed Death Among the Mentally Retarded |
Washington Post Staff Writer
Sunday, March 14, 1999; Page A01 First of two articles
Elroy lives here. Tiny, half-blind, mentally retarded, 39-year-old Elroy. To find him, go past the counselor flirting on the phone. Past the broken chairs, the roach-dappled kitchen and the housemates whose neglect in this group home has been chronicled for a decade in the files of city agencies. Head upstairs to Elroy's single bed.
"You're in good hands," reads the Allstate Insurance poster tacked above his mattress -- the mattress where the sexual predator would catch him sleeping. Catch him easily: The door between their rooms had fallen from its hinges. Catch him relentlessly -- so relentlessly that Elroy tried to commit suicide by running blindly into a busy Southeast Washington street.
These days, reconciled to living, Elroy has fashioned ways to cope. He keeps private amulets against a misery he doesn't fully grasp. There's the leatherette Bible he can't read; the Norman Rockwell calendar of family scenes he hasn't known.
And there's his strategy of groping his way down to the bare-bulbed basem*nt again and again to wash the sheets from his violated bed, as if Tide could cleanse defilement. "God is a friend of mine," he says. But absent divine intervention, "you just gotta do what they say." Just got to add soap powder, and more soap powder, turn the dial to hot. "Gotta not let the worries pluck your nerves."
A decade ago, the District government, compelled by a federal lawsuit, carried out a celebrated rescue of some of its most vulnerable citizens. It closed Forest Haven, the notorious asylum for the retarded in Laurel, where Elroy had grown to adulthood. In its place, the city fashioned one of America's costliest reform efforts for the retarded: dispersing Forest Haven's 1,100 residents, and the other people subsequently committed to city care, into small, privately operated group homes scattered throughout the District. This new, community-based system would provide sensitive, individualized care in homelike settings -- care monitored by a large network of city and federal protectors.
But today this reform is failing. In the 1990s, District and federal taxpayers have unwittingly financed a system marked by municipal ineptitude and private profiteering: a system that has fostered abuse and even death. An investigation by The Washington Post -- which included visits to group homes and the therapeutic programs where the retarded spend their days, examination of tens of thousands of records, and interviews with retarded men and women -- found:
The cost of this publicly funded system of care -- group homes, day treatment, medical services -- is about $100,000 per person per year. Elroy is one of the system's 1,100 current beneficiaries: retarded people who, for financial, developmental or other reasons, aren't being cared for by relatives and can't live on their own. Each is assigned to one of the city's 150 group homes, most of which are run on a for-profit basis by health care entrepreneurs. Some of the homes offer competent and affectionate care, city records and home visits indicate. But behind the nondescript doors of other group homes lives a reminder of why Victorian reformers erected vast asylums in the first place: to prevent abuse and exploitation of the retarded in a community's darker corners.
Presented with The Post's findings, city officials professed ignorance of many specifics but acknowledged systemic shortcomings such as poor monitoring, miscommunication among agencies and a failure to fine companies that neglect or mistreat the retarded. "The situation didn't get this way overnight," said Department of Human Services Director Jearline F. Williams, who has overseen the agency since 1997. "And it's going to take some time to turn this around. But I assure taxpayers that there will be dramatic and visible improvements."
Elroy has endured the District's caretaking inadequacies since he was a toddler. The Post is withholding his last name for privacy reasons, because he has been sexually victimized. He lives in a group home run by entrepreneur Rollie Washington and his wife, Dorothy. Real estate records note that there are 11 bathrooms in the million-dollar Upper Marlboro "Manor Farm" where the Washingtons make their home. A city report recently noted that the home they provide for Elroy had no toilet paper. It did have vermin and broken furniture and, city records show, a long record of ill-serving its inhabitants. The Washingtons' company wasn't licensed to do business in the District from 1993 until late 1998, records show. Still, the city government paid their company millions of dollars over those six years for the services they provided Elroy and others.
The world of "simple" people is in truth a complicated place: Words elude, stories shift, times and places blur. But a tour of that world fixes one fact pretty firmly: Even people with IQs of 50 know this isn't the way life is meant to be.
The Altruist's Dream
For some of Elroy's friends, the policy revelation arrived too late: They left by way of Forest Haven's basem*nt morgue. But Elroy and a thousand others survived to reap the fruits of a federal lawsuit pressed since 1976 by the parents of several residents. In 1990, a judge began fining the city heavily to force a shutdown, and the Justice Department's Civil Rights Division joined the parents' suit, launching its own investigation of poor medical care at the asylum. Meanwhile, city and federal officials -- recognizing that the retarded can't defend their own civil rights and that many have been abandoned by their best protectors, their families -- erected a labyrinth of organizations and agencies to protect them.
Each retarded person would receive from the city an annual, individualized plan for therapy and services in a group home and in a separate day program. Ex-Forest Haveners would even be guaranteed a regular vacation. Court-appointed monitors and lawyers, trained personal advocates and other designated protectors would ensure that the city delivered this promised care.
But who exactly would take them in -- some drooling and vacant and crib-bound, a few given to eating their own clothes, none unmarked by their institutional experience? In the beginning, altruists stepped forward, as expected: groups like the religious, nonprofit Community of the Ark, which has operated two group homes in the District since the mid-'80s. In those Ark homes today, the walls blaze with the oil-paint issue of Saturday art classes at the Corcoran. A staff member flips flashcards to teach a resident her address. Another resident peels carrots and accepts congratulations on the second anniversary of his Arlington movie theater job. Then all gather for a pre-dinner prayer, at which well-groomed ex-Forest Haveners hold hands (and paws if you include the house cat, Milton) and sing:
Giving me the things I need
The sun and the rain and the apple seed.
This is what deinstitutionalization's dreamers had in mind. But of the thousand-plus ex-Forest Haven residents, the Community of the Ark could take exactly eight.
While there were other well-motivated group home operators, the District's system swiftly came to be dominated by firms with an interest in profit. Today, more than 80 percent of the group homes are run by for-profit providers, some of them attracted by the city's decision -- made under pressure of mounting federal court fines -- to pay rates as high as $500 a day per retarded client, among the most generous pay schedules in the country.
In their effort to expand the network of group homes quickly, city officials entrusted most of the oversight of the new contracts to an obscure unit of the Department of Human Services: the Mental Retardation and Developmental Disabilities Administration. But that office had little monitoring staff to ensure that the claims of would-be providers had some basis in reality. Moreover, many of the caseworkers directly charged with safeguarding group home residents were former members of the Forest Haven staff -- who, after years of spooning prunes or supervising calisthenics, had been haphazardly retrained and were now supposed to keep an accountant's eye on client funds and monitor medical treatment.
"In the early days, you could pretty much count on providers to be sincere about their commitment," recalls Vincent Gray, who headed the Department of Human Services when Forest Haven closed. "Then, as the dollars began to increase and the need for more homes began to increase, you began to see more people coming on the scene as a business venture. That became a serious problem. Those in it for financial gain needed much more sophisticated monitoring. But this was a system based on trust."
Running the system on trust reflected the philosophy of some advocates for the retarded, too. Desperate for the new system to succeed, they feared that criticism of the group homes could be misconstrued as an endorsem*nt of asylums. Betty Evans, mother of a young woman who died at Forest Haven and one of the lead actors in the federal suit, was one of many who urged restraint in publicizing troubles in the homes. "They may have problems," she recently told The Post, "but they're better than Forest Haven."
Into this fragile and forgiving civic infrastructure came entrepreneurs like Rollie Washington.
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